Midwife Faces Charges in Home Birth

Dogs and goats and babies and grandmas converge at Rainbow’s End farm, and in the middle of it all is Nan Koehler, a bold and radical woman whose cracked, strong hands have coaxed more than a thousand babies into the world.

Twelve miles away, past vineyards heavy with grapes, lies a young boy, Trystan Condon, struggling to drag his body an inch forward on a small blanket. It will take him 10 minutes.

At 2 1/2 years, Trystan cannot say his name, cannot feed himself, cannot roll over. Medical reports describe him as profoundly brain-damaged.

Prosecutors, some doctors and Trystan’s parents say Koehler is to blame. They accuse her of allowing his mother to labor dangerously long and failing to summon help quickly enough when he was born struggling to breathe. She faces up to 10 years in prison if convicted of child endangerment and practicing medicine without a license. Her preliminary hearing is scheduled for January.

The lives of this baby and this “direct-entry” or lay midwife are inextricably linked now by issues that go far beyond his delivery in a Sonoma County garage.

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Koehler, 61, who was born in Germany and became a Quaker at 16, considers herself first a mother, second a farmer and third an idealist. She wrote a book about pregnancy, birth, families and herbal healing called “Artemis Speaks,” which is an essential reference for many midwives. But her proudest moments, she once said, were giving birth to her own five children, four at home.

Striding around her farm, she looks like a sweet grandmother with long blondish-gray braids that swing as she walks. Her big kitchen is a hub of activity -- grandchildren playing, friends popping in for mugs of organic herb tea.

For years, she assisted women choosing home birth, backed up by her husband, an obstetrician. (They are separated now and he was not involved in Trystan’s birth.) But Koehler was sued about 10 years ago after a baby died. The case was settled and sealed. After that, she began turning down requests to assist in deliveries.

But Toni Sorenson and her husband, Mark Condon, had a friend whose babies Koehler had helped deliver. Toni Sorenson visited Rainbow’s End farm for a mothers’ gathering and watched videos of home births with Koehler assisting.

Koehler said she didn’t do deliveries anymore, but relented after Sorenson asked her to reconsider, with the caveat Sorenson would need to take responsibility for her own well-being.

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Many details about the birth of Trystan Condon on Feb. 28, 2000, are in dispute. Trystan’s parents and Koehler won’t discuss the case because of the criminal charges and the lawsuit that the parents have filed against Koehler.

But the state medical board’s investigative report -- based on interviews with doctors, nurses, Koehler and Trystan’s father, Mark Condon -- provides a version of events.

Condon told investigators that his wife went into labor about 6 a.m. on Feb. 27, 2000. By 6 or 7 that evening, around when Koehler arrived, Sorenson was feeling the urge to push.

Around midnight, he said, Koehler told her to stop pushing for a moment while she tried to reposition the baby’s head. Four hours later -- still pushing sporadically -- they moved to the garage, where Koehler had told Condon to hang a birthing rope from the ceiling. Sorenson pulled on the thick, knotted rope to ease the pressure.

Around 9 a.m., 27 hours after labor began, Koehler told them that the umbilical cord was wrapped around the baby’s neck and that the heartbeat was slow. She started chanting -- Koehler often sings soothing lullabies during labor -- and she told them that it was time to get the baby out. Condon, according to his account, got behind his wife, lifted her up, wrapped his arms under her knees and helped her push.

Moments later, Trystan was born. The cord was indeed wrapped around his body; he was struggling to breathe and his skin was blue.

Koehler cleared his nose with a suction bulb and began chest compressions and mouth-to-mouth resuscitation. Her assistant brought two bottles of oxygen from the car, but one was empty.

When the baby was breathing, Koehler started the second bottle; but after a few minutes, that one ran out. Koehler told Condon to get more oxygen at a fire station.

That is what Condon reportedly told investigators.

Koehler’s attorney says that the baby was recovering and that her client sent Condon for oxygen simply because “she needed to find something for him to do.”

Friends of Koehler’s who were not at the birth maintain that she suggested calling an ambulance during the birth but could have been more persistent about it. Condon told investigators that Koehler discouraged him from summoning help.

Paramedic Stephen Curtis told investigators that his crew rushed to the house after Condon showed up. They found the baby being held by his mother. The midwife told him that she thought the baby was improving and didn’t need to go to the hospital, Curtis added.

Paramedic Steve Bishop, also there that morning, told investigators that Trystan was obviously in respiratory distress. He said no one argued when they took him to the hospital.

Dr. Harry Ackley, medical director of Sutter Medical Center in Santa Rosa, admitted Trystan to intensive care. The doctor told investigators that he spoke with Koehler the next day and that she told him the second stage of labor -- when the mother is fully dilated and pushing -- was “longer than normal.”

This stage, which normally takes 45 minutes, was allowed to go on much too long, Ackley told investigators. It is considered prolonged if it continues for more than two hours.

There are different protocols for dealing with a prolonged second stage of labor. If the baby is not in distress and the labor is slowly progressing, some midwives will let the delivery continue. If the baby is facing up, some practitioners may try turning it. At many hospitals, a prolonged second stage of labor prompts doctors to perform a Caesarean.

Obstetrician Diane Sklar, who reviewed the medical board’s findings, told investigators that Koehler should have taken the mother to the hospital after two hours of pushing.

“By allowing the pushing to continue for at least seven to nine hours, the baby was exposed to a prolonged lack of oxygen,” Sklar wrote. She concluded that Koehler “directly caused the brain damage in this baby.”

Months after the birth, a medical board investigator spoke directly with Koehler.

“She said she wanted to talk to me about the delivery of Trystan Condon, but was afraid I would not understand,” the investigator reported. “Koehler explained that she is ‘from a different world.’ ”

In her books, lectures and consultations, Koehler says that birth is a normal biological event and that she does not agree with the medical establishment’s perspective of birth as a possible emergency.

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To say that Nan Koehler has a broad support network is an understatement. The thousands of families she has touched, either by helping deliver their babies or by teaching the midwives that delivered them, spread across the country.

Since she was charged, donations for her legal defense have poured in. Musicians have held benefit concerts. A lawyer is donating his time. Sebastopol Mayor Sam Spooner declared Oct. 15 Nan Koehler Day.

Joan Risse, the prosecutor, says she believes that a woman has a right to give birth at home if she chooses, but that the state also has an interest in protecting the health of the baby. If Koehler is found guilty, she said, “maybe people will think twice before doing the same thing.”

Koehler’s lawyer, Jamie Thistlethwaite, shudders at the thought of her client going to prison.

“Her heart breaks for [Trystan’s] family,” she said. “It will be an absolute tragedy if this good, kind, compassionate woman goes to jail for trying to help someone.”

According to the state medical board, Trystan’s prognosis “is very poor due to profound brain damage.” One doctor suggested putting him in an institution, but the parents have no such plans. Toni Sorenson and Mark Condon spend their days caring for their child.

Anyone who has spent time with this boy, who has pushed his soft hair off his forehead and stroked his cheek, who has seen him turn his head and smile, can understand why his parents have faith. They have faith as they drive him from appointment to appointment, day after day, and wake up night after night to roll him over or sit him up or pat him.

In a few months, they will relive the frightening birth and devastating aftermath in a courtroom, in the press, with their neighbors.

The result could be the devastation of another family -- the friends, relatives and supporters linked by Rainbow’s End farm.